key: cord-0068227-9npaev6t
authors: Scarborough, Alexander; Geoghegan, Luke
title: Letter to editor: "The role of teleconsultation in the management of suspected skin malignancy in plastic surgery during COVID-19 outbreak: A single centre experience”
date: 2021-10-07
journal: J Plast Reconstr Aesthet Surg
DOI: 10.1016/j.bjps.2021.09.018
sha: a22fd8bc87ff21ab3642a0ede079cf14295b9355
doc_id: 68227
cord_uid: 9npaev6t

nan

We read with great interest the article entitled "The role of teleconsultation in the management of suspected skin malignancy in plastic surgery during COVID-19 outbreak: A single centre experience" (1) . We agree with the authors that the COVI-19 pandemic has brought unique challenges and necessitated rapid adaptation, however we have questions for the authors regarding their methodology, reporting and conclusions drawn from the present study.

The authors found a 10% "on the day" change in the nature of the surgical procedure in the telemedicine group, compared to 1.7% in the face to face group. Who made the decision to deviate from the planned operative procedure on the day of intervention and were they blinded to participant allocation status (telemedicine vs face to face consultation)? If not then the risk of conduct bias is non-negligible, particularly given all patients were under the care of a single named consultant.

The authors report a higher proportion of patients with squamous cell carcinoma (SCC)/melanoma referred to the teleclinic compared to the face-to-face clinic (35% vs 6.7%). Further, the authors report a higher proportion of patients referred to the urgent skin cancer pathway and a greater assessment accuracy for patients assessed via the teleclinic pathway. Is this discrepancy in the proportion of basal cell carcinomas vs SCC/melanoma related to service disruption secondary to Covid-19? How did the overall number and relative proportions of each skin cancer type change before and during the pandemic?

Finally, the average age of patients was 71.8 years. Were participants recruited based on technological literacy? If not, was any training provided to participants to share clinical photographs to aid in virtual diagnoses? Widespread adoption of such technology risks widening disparities in access to healthcare from both a technological literacy and socioeconomic perspective.

Telemedicine is likely to comprise a major component of future healthcare and there is no doubt the COVID-19 pandemic has accelerated this change. We are thankful to the authors for publishing their experience. A previous survey of hand surgeons and therapists (2) has shown high uptake of telemedicine consults for post-operative follow up, with comparatively fewer surgeons opting for teleconsultation in the assessment of new patients. We would be interested to learn whether the authors have used telemedicine consults for post-intervention follow up alongside initial clinical assessment.

The role of teleconsultation in the management of suspected skin malignancy in plastic surgery during COVID-19 outbreak: A single centre experience

Implementation of virtual consultation for hand surgeons and therapists: an international survey and future implications